Full Trust statement – A&E waiting time performance

February 22, 2016

Image: Tom Boon

Full statement from Nick Carver, Chief Executive of East & North Herts NHS Trust received on Thursday 18th February, 2016.

“The standard set nationally for the NHS is that 95% of those attending A&E are seen, treated and either discharged or a decision to admit them is made within four hours of their arrival. The NHS as a whole has struggled to meet this standard consistently since September 2014, following changes in both the level of A&E attendances and the numbers of frail elderly patients brought in by emergency ambulance to hospitals across the country. There has also been changes to the patterns of attendances, which now remain high across the year.

“The challenging performance picture facing the NHS nationally has also been seen locally here in Hertfordshire, with the numbers of patients attending the Lister’s emergency department and the urgent care centre at the New QEII hospital rising from an average of around 350 patients a day back in 2013 to some 420 a day by last year. Although the Lister’s new £19 million emergency department – which saw its capacity doubled – when it opened fully in October 2014 – offers a great service, it has seen a significant arise in very ill elderly patients, often with multiple and complex health needs, being brought to the Lister by emergency ambulance.

“Over recent weeks in particular attendances have breached 500 a day, which has impacted on waiting times for those with conditions and injuries that are not life-threatening. In turn, this has contributed to the Trust missing its A&E waiting time performance – although it has improved since December 2015 when a recovery trajectory was agreed with the NHS Trust Development Authority.

“Winter is one of the busiest time of the year for NHS hospitals when it comes to emergency care, especially the first two months of the year. This is often when the weather is colder, as it has been recently and illnesses like ‘flu are circulating – which can be very serious for those with long-term respiratory conditions or who frail and elderly.

“The parts of the Trust that takes the brunt of these pressures include A&E, our assessment units, emergency surgery services and wards taking emergency medical and surgical patients. Pressures in any of these services can cause problems in other areas within the Lister. In essence maintaining emergency services is about managing and maintaining patient flows through the hospital, including timely discharges back to where people live.

“Prior to the changes made to the Lister and QEII back in 2013/14, the Trust had some 750 beds across the two hospitals; today it has around 720 just at the Lister, which includes a new 14-bed ward opened at the Lister on 5 January that forms part of our winter planning contingency plan.

“The emergency department at the Lister has doubled its capacity and physically is three times the size of the old A&E. It also employs more doctors and nurses than before – indeed this year the Trust has increased staffing levels in the emergency department to meet recommendations set out by the National Institute for Health and Care Excellence (NICE).

“Despite all of these initiatives, the Lister’s emergency department has been exceptionally busy over recent weeks – in December, 80.5% of those attending were seen, treated and either admitted or discharged home within four hours of their arrival. The standard we are expected to reach is 95%, although the Trust’s performance was broadly at the average for the NHS as a whole that month.

“Since the start of January – and despite the additional ward that was opened – the level of admissions has remained very high, which in turn places large pressures on the system – especially in our emergency department, where more people wait to be seen for longer than we would like.

“No one waited more than 12 hours once the decision to admit them was made – the second standard that A&Es across the country have to meet – although some people with non-life threatening conditions will have had to wait in turn as the focus of our doctors and nurses has to be on those whose lives are at risk.

“The average number of patients being admitted as an inpatient at the Lister over the winter sits at about 2,900 people a month – which places real pressures on the hospital in terms of bed capacity. Whilst the number of people awaiting to be discharged from the Lister is always a factor, the Trust has good working relationships with its local social services and community health colleagues making the situation in Hertfordshire better than other parts of the country.

“Sometimes people suggest that these problems have been caused by the changes that led to inpatient and emergency services being transferred from the QEII to the Lister a year or two ago. The answer to that is simple – if the changes had not been made, then we would be in a far worse position. We would have had too few staff spread too thinly across both sites; we also would not have had the investment in to the Lister’s emergency department. Quite simply without the changes, we would not have been able to cope.

“It has been a very challenging winter thus far, with very little capacity in neighbouring NHS hospitals to help – everyone is in the same position. We are managing, although some people do wait to be seen in A&E for longer than we would like. This is why we have established a new project – led by our doctors and nurses – to review every step in our emergency care pathway to see what changes can be made to make things better going forward.

“In the meantime, our staff are doing their best – and despite some people having long waits – to ensure that they provide high-quality, compassionate care.”